This is their world: Medical school course offers students a glimpse at the roots of their patients’ problems

In 2011 and I was working at a further education college with students with profound learning disabilities. One morning, we were having a staff meeting and it was stated at this meeting that the principle of the college was taking a hard line with attendance across the entire college. Any student that arrived even a few minutes late, or had more than a few days off sick, would potentially fail their course.

I remember sitting there feeling incensed at this blanket statement and compelled to challenge my line manager. Was I really part of an organisation that had so little insight into the world of all the students and young adults I was working with? Young adults and their families that had already overcome multiple health issues (some potentially fatal). That lived in a world where the simplest of tasks could take an hour instead of minutes to achieve, like getting showered and dressed in the morning. Where just from moving from one location to another, took thought and time. This was their world and their life and they arrived each day with a smile on their face.

I had never, personally, had to manage complexities like this in the morning, before my woman-2696408_1280children’s educational day started. I had however experienced trying to get my 9-year-old and 4-year-old twins to school after their sister had died. One particular morning it all got too much for me as I just lacked the emotional strength to get them all ready on time. My mind was a fog and I felt like the tiniest of tasks might as well have been a monumental task.  As as I fought against the clock this particular day,  I crumpled and ended up laying on my kitchen floor sobbing. I knew the longer I laid there debilitated by anxiety and sadness, I knew they would be later and later…..suddenly though it hit me…..I do not care if they are at school for 9am. Bugger picture Carolyn. Real life Carolyn. My priority should be that they are emotionally ok. I pulled myself up off the floor, called the schools, told them they would be in when WE were ready, put the phone down and made myself a cup of tea. I went on to make them all a special breakfast and allowed us just to be. They went to school an hour late and I am proud of that hour they were with me.

Why is this important, well it is because we are all operating in our own real lives and real world and lets not pretend…some people’s worlds are more challenging than others. It will always be the way. I have gone through my fair share of grief, but I live in a guy-2617866_640country that in my lifetime has not been war-torn. I have a home in a nice safe and pretty town. I have a mind, voice, and body that I can utilise fully and I have never had to be homeless. Just some of the things I am grateful for. Empathy is about seeing how things are for another…from their perspective. It is not about pity, but reality and about understanding some of the why’s and therefore understanding what someone may need for you to support them in a meaningful way.

A new initiative in a medical training programme in America, has doctors learning through patients real life and their real lived experiences. As I do when I work with healthcare professionals, complaints teams and investigators, taking them on a journey of patient safety, complaints and empathy that goes outside procedure and textbooks,  to encompass a much deeper understanding, this initiative too goes beyond medical learning and assesses it in real life.

In an article in the USNews  it states that ‘Medical students may spend years toiling over birth, death and all that ails people in between. But when it comes to keeping patients healthy, the key often lies outside the textbook or operating room.

That’s the lesson instructors are seeking to impart through a novel course at the University of Pennsylvania’s Perelman School of Medicine: In order to best serve the patients they see in the medical setting, doctors should know who those patients are outside of it.

“It is increasingly clear that you need to teach medical students – and for that matter, nursing students – more than just the pathways of clinical medicine in order to be a good doctor,” says Dr. Shreya Kangovi, an assistant professor who developed the course. “It’s not just about genetics and biochemistry, but it’s about the other competencies like cultural humility and good communication and patient engagement.”

The Penn course, an elective that lasts either two or four weeks, flips that relationship on its head. Third- and fourth-year students serve as apprentices to community health workers – health educators and navigators who work in their own neighborhoods and serve as liaisons between the health care system and patients who may face community-based hurdles to staying healthy, like a lack of transportation, unstable housing or inadequate access to healthy food.

Through the course, students learn how to address these health barriers while also recognizing the expertise of community health workers – care team members whose roles require staunch interpersonal skills and resourcefulness rather than years of clinical training.

“There is a 180-(degree) switch in the power dynamic, where this working-class person from the community, not making a whole lot of money, is now serving as the supervisor and evaluator of the student,” says Dr. Horace DeLisser, an associate professor at Penn who also serves as an associate dean for diversity and inclusion and helped develop the program.

“It helps challenge the student’s thinking, it fosters humility, hopefully develops some graciousness about people who are different from them, or at least not part of their normal experience,” DeLisser says.

I totally applaud this initiative and I know from the feedback I get from healthcare professionals attending my training days, that being able to gain an insight that challenges their perspectives and supports a deeper level of empathy to empower their connection and abilities, that these medical students will be receiving knowledge that no medical book can adequately educate them in. Whether it is a doctor, complaints manager, or a principle of college, knowing some of what the real-life factors and implications of certain situations are in another’s life, provides the understanding and education to make intelligent, insightful and more compassionate decisions, that support people to make others real life a little easier, rather than harder. Wouldn’t we all wish for that?

For more blogs and news from Carolyn and C&C Empathy Training Ltd see HERE

Email: carolyn@cc-et.co.uk 

Twitter: @carolynccet

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Doctors giving empathic statements, allowing time for family members to respond were more likely to learn important information.

In a qualitative study of 68 pediatric intensive care consultations with 179 family members, to address the question: ‘When doctors attend to family emotions, how does it influence ensuing communication?’ found that using empathic statements gained important information. Giving time for family responses (coded as an unburied response), rather than just burying empathy in a mass of medical information (coded as a buried response), the doctors were more likely to learn important information about the family’s fears, values, and motivations.

The study states that ‘Families have consistently reported a desire for their doctors to show empathy. Empathy is a vital component of high-quality health care, and medical staff statements of empathy are an important source of support for patients and their families. Literature from adult ICUs suggests doctors infrequently show empathy and often miss opportunities to connect with families.’

When things go wrong in healthcare, this approach of empathic communication is vitally important still. In fact, when a resolution is sought, empowering staff to gain access to patient and loved ones, fears, values and motivations, is a key component.

“You will never be able to hit a target that you cannot see” Robin S Sharma

So often when conflict arises, the view is that both sides need to get back to a place of no conflict. Yet, as I discuss when training healthcare professionals, and complaints teams/serious incident investigators, their starting point is already a conflict of interest. The organisation is often coming from a procedural driver and the patient and/or loved one, from an often very strong emotional driver. They have an emotional investment because this is their life or the life of someone they love. Both sides often having fear, conscious or unconscious impacting on them.

When a death has occurred, grief processes can get stuck and whilst much is spoken about patients and loved ones never wanting things to happen to anyone else, it must not be forgotten that this frequently publicised driver is embedded very firmly in the fact that something has already happened to them or their loved one. They, therefore, have their own fears, values and motivations pushing them forward.

Empowering staff to understand this and gain more confidence to respond to it, as shown with the challenging communication between paediatric doctors and the families of critically ill children, interactions are enhanced through the understanding and demonstration of empathic communication. Being seen, heard and understood is vital in building a relationship with another and never more vital that when that understandable conflict of interest is already present.

To know more about how training that C&C Empathy Training carries out can support healthcare and complaints organisations, see here.

For the full website, please see www.empathytrainingltd.co.uk

Carolyn Cleveland, the founder of C&C Empathy Training, has a background of counselling and psychology, specialising in bereavement, fear and anxiety, but has also gone through the NHS complaints system, bring an authenticity and real-life application to her training programme. 100% of those attending in the last 12 months would recommend her and her programme.